The Sick House Syndrome: Indoor Air Pollution

The Sick House Syndrome: Indoor Air
Pollution

Scene 1:
A brick walled house in a narrow by lane of a typical urban
slum of Lucknow. A small open veranda leads to two small,
dingy and damp rooms, with no access to sunlight, and hardly
any ventilation. One of the rooms doubles up as a kitchen,
which has a chulha (mud stove) run on wood fuel. The smoke
from the stove and from the bidis (cheap cigarettes) smoked
by the family head lingers in the suffocating environs where
Shiv Prasad, a daily wage labourer, his wife Ramdulari and
his 4 children manage to eke an existence. Shiv Prasad
underwent TB treatment 7 years ago (the cough has returned
again) and his 6 years old son is currently on treatment for
pulmonary TB.

Scene 2: A mud house in a village
bordering the district town of Gonda. A joint family of
several members uses wood fuel stove, and the youngest
member—three and a half month old Hasan--recently suffered
from severe pneumonia and had to be shifted to a private
hospital 150 kilometres away in Lucknow when the local
doctors gave up on him. Fortunately the child
survived.

Scene 3: A modern 3 bed room apartment in
a posh locality of a metro city inhabited by the Sharma
family. The children’s rooms are air conditioned with very
little scope for fresh air/sunlight to enter. Mr Sharma is
an avid smoker and with smoking being banned in public
places, he finds the closed confines of his home to be the
most convenient place to satisfy his addiction. His 10 year
old daughter Neha suffers from asthma and has to carry her
inhaler in her school bag every day.

All these real life
examples are bound by one or more of three common
threads—polluted air circulating in the house from
incomplete combustion of burning of solid biomass fuels like
wood/coal/cow dung (used by 826 million Indians), poor
ventilation and tobacco smoke (which releases more than
4,000 chemicals, of which at least 250 are harmful, and more
than 50 are known to cause cancer). This endangers not only
the smoker but also others present in the vicinity. Most of
the acute respiratory infections (ARIs), which kill over I
million Indians every year, are associated with indoor air
pollution.

Dr Donald Enarson, who is expert on lung
health, tuberculosis and indoor air pollution at the
International Union Against Tuberculosis and Lung Disease
(The Union), elaborates to Citizen News Service (CNS) that,
“Other causes (besides tobacco and bio fuel smoke) leading
to respiratory diseases include overcrowding and poor
ventilation that increase the concentration of harmful
infectious and toxic agents indoors. In houses, offices and
even in airplanes, when ventilation is reduced to seal the
environment for cooling/heating purposes, it leads to an
increase in respiratory and general illnesses called the
sick building syndrome.”

Indoor air pollution is
responsible for 2.7% of the global burden of disease. Three
types of lung diseases have a strong association with solid
fuel smoke: (i) acute lower respiratory infections (ALRIs)
in children, (ii) chronic obstructive pulmonary disorder
(COPD) in women, and (iii) lung cancer in women exposed to
coal smoke. According to the World Health Organization,
worldwide nearly 2 million people die each year from
diseases caused by unhealthy cook stove technologies,
including more than 1 million people, mostly women, dying
from COPD. Nearly half of deaths among children under 5
years old from ALRIs are due to particulate matter inhaled
from household solid fuels’ smoke and 1.5% of annual lung
cancer deaths are also attributable to exposure to
carcinogens from polluted indoor air.

Several children
being treated for pneumonia at the Bahraich District
Hospital and Nelson Hospital of Paediatrics and Neonatal
Medicine Lucknow were found to be coming from families which
used wood/charcoal cook stoves and where elders habitually
smoked bidis/cigarettes, suggesting that cigarette and cook
stove smoke increases the risk of pneumonia in children. The
Acute Respiratory Infections Atlas confirms that indoor air
pollution significantly increases the incidence of pneumonia
which globally kills close to 1 million children under 5,
each year.

Nearly half of the world’s children are
exposed to tobacco smoke in their daily lives, which doubles
their chances of developing ARIs. Foetuses are at special
risk, and abnormal lung function at birth may result in more
severe infections in infancy. Non-smokers who are exposed to
tobacco smoke in the workplace or at home face a 25% to 30%
greater risk of heart disease and a 20% to 30% greater risk
of lung cancer.

Dr Ajay Misra, Managing Director of Nelson
Hospital of Paediatrics and Neonatal Medicine feels that,
“Even living in posh houses behind closed doors and
windows, with no proper ventilation and flow of clean air,
poses a danger to lung health.”

Professor Surya Kant,
Head of the Pulmonary Department, King George’s Medical
College, feels that, “Passive smoking and exposure to
biomass smoke are also risk factors for developing active TB
disease, especially in children. Cooking fumes and cigarette
smoke can also trigger asthma attacks. So the practice of
using biomass fuel should be replaced by other safer energy
options. A house should be neat and clean, with proper
ventilation and admit natural sun light and people should be
made aware not to smoke inside homes or in presence of
children.”

In the opinion of Dr. Kumud Anup, a
practising paediatrician of Lucknow, “In urban areas
tobacco smoke is a major source of indoor air pollution.
Children are exposed to second hand smoke which is extremely
dangerous and increases the risk of pneumonia. Tobacco smoke
greatly increases the susceptibility to not only pneumonia
but also asthma and several other lung infections.”

Yet,
there is a dismal lack of awareness in the common public and
even in the medical community about the ill effects of
polluted air circulating in living spaces. Dr PK Mishra, a
gynaecologist at the District Hospital, Bahraich, believes
that, “Tobacco smoking or cooking on chulhas does not
directly increase risk of childhood pneumonia. It can
suffocate the child but it does not lead to any
infection.”

Dr Enarson rightly insists that, “It is
important to educate people about the dangers of open
exposure to biomass and tobacco smoke so that they can take
simple inexpensive precautions to reduce the problem.
Shifting from biomass to liquid fuels is an important step
forward but this may not be practical for very poor people.
So it is best to do the cooking with biomass fuel either
outside or in a separate room away from the main house.
Improvements in ventilation (planning open windows or
ventilation shafts under the eaves), using simple
‘enclosed stoves’ and preparing venting chimneys are
practical ways to improve the situation. And the most
crucial thing is to prevent people from smoking
tobacco.”

*************

Shobha Shukla is the Managing Editor of
Citizen News Service (CNS). She is a J2J Fellow of National
Press Foundation (NPF) USA. She has worked earlier with
State Planning Institute, UP and taught physics at India's
prestigious Loreto Convent. She also authored a book on
childhood TB (2012), co-authored a book (translated in three
languages) "Voices from the field on childhood pneumonia"
and a report on Hepatitis C and HIV treatment access issues
in 2011. www.citizen-news.org

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